KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.
Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
Phys Ther. 2022 Jun 3;102(6). doi: 10.1093/ptj/pzac014.
Best practice guidelines recommend that aerobic exercise (AEx) be implemented as early as possible poststroke, yet the prescription of AEx remains limited in stroke rehabilitation settings. This study used theoretical frameworks to obtain an in-depth understanding of barriers and enablers to AEx implementation in the stroke rehabilitation setting.
A qualitative, descriptive study was conducted. Participants were recruited from 4 stroke rehabilitation settings in Ontario, Canada, that have participated in an implementation study to provide structured AEx programming as part of standard care. Six clinician focus groups (with 19 physical therapists and 5 rehabilitation assistants) and one-to-one interviews with 7 managers and 1 physician were conducted to explore barriers and enablers to AEx implementation. The Theoretical Domains Framework and Consolidated Framework for Implementation Research informed content analysis for clinician and manager perspectives, respectively.
Barriers specific to resource constraints and health care system pressures, combined with patient goals, led to interventions to improve function being prioritized over AEx. Successful implementation was enabled through an interprofessional approach and team engagement in the planning and implementation process. Health care providers described concerns about patient safety, but confidence and capability for implementing AEx were enabled by education, skill development, use of exercise tests, and consultation with individuals with content expertise. Participants described the development of supportive processes that enabled AEx implementation within team workflows and shared resources.
Strategies to support implementation of AEx in stroke rehabilitation should incorporate knowledge and skills, the provision of clinical decision-making tools, access to expert consultation, the roles and social influence of the interprofessional team and formal and informal leaders, and supportive processes adapted to the local context.
Results from this study will inform the development of a clinical implementation toolkit to support clinical uptake of AEx in the stroke rehabilitation setting.
最佳实践指南建议，应在中风后尽早实施有氧运动（AEx），但中风康复环境中对 AEx 的处方仍有限。本研究使用理论框架深入了解中风康复环境中实施 AEx 的障碍和促进因素。
这是一项定性描述性研究。参与者是从加拿大安大略省的 4 个中风康复机构招募的，这些机构参与了一项实施研究，以提供作为标准护理一部分的结构化 AEx 编程。共进行了 6 次临床医生焦点小组（有 19 名物理治疗师和 5 名康复助理）和 1 次与 7 名经理和 1 名医生的一对一访谈，以探讨实施 AEx 的障碍和促进因素。理论领域框架和实施研究综合框架分别为临床医生和管理人员的观点提供了内容分析。
资源限制和医疗保健系统压力的具体障碍，加上患者目标，导致优先考虑改善功能的干预措施，而不是 AEx。通过跨专业方法和团队参与规划和实施过程，实现了成功的实施。医疗保健提供者描述了对患者安全的担忧，但通过教育、技能发展、使用运动测试和向具有专业知识的人咨询，增强了实施 AEx 的信心和能力。参与者描述了在团队工作流程和共享资源中支持 AEx 实施的支持性过程的发展。
在中风康复中支持 AEx 实施的策略应纳入知识和技能、提供临床决策工具、获得专家咨询、跨专业团队的角色和社会影响力以及适应当地情况的支持性过程。
本研究的结果将为开发临床实施工具包提供信息，以支持在中风康复环境中采用 AEx。
